Seeing the lack of published evidence on how or why this gait type develops in children and its long-term effects on the foot and ankle, the authors sought to summarise what is currently known about Idiopathic Toe-walking (ITW), primarily relating to the diagnosis of the gait type.
The four founding publications in paediatric gait development observed children without disabilities, and they all describe children’s ability to walk on their toes.
They indicate that although toe-walking is not a mandatory phase, it is a common component of gait development for the young child.
There are many medical conditions that are reported as either causing or being associated with ITW – 1) neuromuscular changes in muscle length, innervation, or strength that prohibit heel strike; 2) traumatic or biomechanical changes in the skeletal framework of the pelvis or lower limb that prohibit or inhibit heel strike; 3) neurogenic influences that result in a toe-walking gait yet heel contact is physically possible during gait; 4) ITW, or toe-walking when there is no medical condition causing or associated with the gait style.
Careful and methodical biomechanical and neurologic examinations need to be conducted to ensure there is a low likelihood of a medical condition causing or being associated with the toe-walking gait.
It is well accepted that ITW is not sex specific and is observed in both boys and girls.
Ankle equinus has long been associated with ITW, with many authors reporting a restriction in the ankle joint range of motion seen in children with this gait type; knowledge of the long-term influence of equinus on foot function may be relevant to predict how the child with ITW gait may be impacted as an adult.
Often the greatest impact of treatment seems to be at the available ankle range of motion, with the toe-walking gait continuing long after treatment has been introduced.
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